Texting for health: Using your cell phone to manage diabetes

Care Smarts offers diabetes self-management with a new and interactive text messaging service through the University of Chicago Health Plan. User Patrece Myles praises the service for delivering daily texts to her cell phone with reminders about medication and other topics.

Courtesy of Patrece Myles

Patrece Myles (left) with her mother, Linda Myles, who also participated in the pilot program to try out Care Smarts with the University of Chicago Health Plan.

Patrece Myles, 40, loves her cell phone.

“I think I would have a stroke if I wasn’t near" it, she laughed.

Now, thanks to a new text message-based diabetes program offered through the University of Chicago Health Plan (UCHP), she loves it even more.

Care Smarts is a free diabetes program offered through the health plan to all University of Chicago employees and staff who have diabetes. Patients in the program receive daily interactive texts from an automated system. Messaging is broken down into two-week content-specific segments such as exercise tips or glucose management. Users also get daily reminders about medication, glucose monitoring and foot care, plus educational facts about diabetes.

Myles, who was diagnosed with Type 2 (adult onset) diabetes 15 years ago, said she loves the program because it’s a convenient way to self-manage her illness.

“Keeping my diabetes under control had actually gotten to be a chore,” said Myles, who is a patient service coordinator at University of Chicago Medicine, the medical center. “I was getting frustrated because I wasn’t getting the results that I wanted to get.”

As she got older, Myles said she noticed her body changing. She started to consider doing the 80/20 diet to lose weight and to reduce her blood sugar. The diet suggests eating 80 percent raw food and 20 percent cooked food.

“It kind of made me look at nutrition from a different aspect. It made me realize that I don’t have to go to that extreme, but I do need to do some things a little differently,” she said.

Now, Myles notices more quickly when she is becoming hypoglycemic, a condition that according to the National Center for Biotechnology Information occurs when a person’s blood sugar is too low. Even her doctor noticed a drop in her glucose levels since she started the program, she said.

Care Smarts grew out of a small 2010 study funded by the University of Chicago and led by Dr. Shantanu Nundy, a clinical instructor at University of Chicago Medicine.

The study targeted low-income African-American diabetes patients living on Chicago’s South Side, where Type 2 diabetes is twice as prevalent compared to national averages.

But according to national data, African-Americans are more likely to own a cell phone than their middle class or Caucasian counterparts, he said. This statistic, and the lack of technology-based research specific to this population, inspired Nundy to create the study.

Eighteen participants represented a broad range of backgrounds and ages, including some 65 and older.

For them, the most noted benefit of the study was the perceived social support, or the feeling of having someone who cared about their health, Nundy said.

“Diabetes is very socially isolating,” he said. “It’s hard to find people who really understand what it is that you’re going through.”

According to the study’s results, participants described the text messaging program as a friend, sponsor, or social group.

Myles agreed that the program feels much like a support group, or a coach, that keeps her on track with her diabetes self-management.

“It brought me that accountability,” she said. “You try to remember to do those extra things, but it makes it that much easier to follow whatever program you’ve agreed on with your doctor if you have somebody saying, ‘Well did you do this today?’”

Self-management, or the ability to manage your own chronic condition through lifestyle choices, is the most important byproduct of the program, Nundy said.

“People win and lose by their diabetes, by what they do at home, at work and in their community—that’s a plain fact,” he said.

And while physicians can give advice on healthier eating and exercise habits, it’s up to the patient to follow the advice once they leave the doctor’s office, he added. It has to be a partnership.

Dr. Rasa Kazlauskaite, with the Rush University Medical Center, also emphasized the need for self-management.

Even though most diabetes patients may visit their doctors regularly, they are their own doctors the majority of the time, Kazlauskaite said. That's why she thinks a program such as this could be very beneficial for the general public, she added.

“A lot of our patients forget to check their blood sugar or forget to take their medication,” she said. “If you can bring the doctor to their pockets essentially, it might be quite useful.”

Rush doesn't offer a text-messaging service. To help her patients remember, Kazlauskaite said, she often recommends smartphone service to set alarms and reminders. Cell phones are a very accessible and relatively cheap media. They could be a great resource for low-income populations, she said.

“Basically, I wish that my patients would use this technology to their advantage. It’s great—it’s a good idea,” she said.

But Kazlauskaite advised that text messages should never become a substitute for doctor’s visits.

Whenever a technology-based program is combined with doctors visits and the doctors are able to tailor messages and reminders to patient needs, it can really help patients learn to self-manage their disease. It’s just important to make sure the text messages are helpful—not information overload, she said.

Care Smarts is now funded by UCHP, but Nundy said he would love to expand the program beyond the university. He said he plans to continue working with organizations to see if expansion is possible.

“The key is that we need buy in from these organizations,” Nundy said.

Myles also said she hopes the program expands to other health care providers so people outside of the university, who have a self-manageable condition, can benefit from it.

She said she also thinks a program like this could benefit younger people who are notoriously more in tune with mobile technology.

“I’m not saying [the program] could save the world, but I think we could have healthier generations to come,” she said.

A text messaging program such as Care Smarts would make it easier to reach children with juvenile diabetes because they’re so attached to their phones and mobile devices, Myles said.